MIRACLE CHALLENGE RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNIFICATION AGREEMENT This Release and Waive of Liability, Assumption of Risk, and Indemnification Agreement (the “Release”) is made and given, in consideration for being permitted to voluntarily participate in the Miracle Challenge Event (“Event”), by or on behalf of __________________________ (“Participant” or “I”) in favor of Children’s Miracle Network, doing business as Children’s Miracle Network Hospitals (“CMN Hospitals”), a Utah non‐profit corporation with its principal place of business at 205 West 700 South, Salt Lake City, UT 84101. I am voluntarily participating in the Event sponsored by CMN Hospitals. I understand that the program may involve strenuous physical activity including, but not limited to, muscle strength and endurance training, cardiovascular conditioning and training, and other various fitness activities including, but not limited to, running, walking, cycling/spinning, boot camp, and studio classes. I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in this Event. I have been advised that an examination by a physician should be obtained by me prior to commencing a fitness and/or exercise program, or initiating a substantial change in the amount of regular physical activity performed. If I have chosen not to obtain a physician’s consent prior to beginning this Event, I hereby agree that I am doing so solely at my own risk. I understand that it is my sole responsibility to only participate in exercises that are appropriate for the current status of my health. If I have any questions or concerns about whether or not a particular activity is appropriate to my current health status, I understand it is my responsibility to ask my doctor if this activity appropriate before I participate in such activity. I understand this Event is not medically supervised, and exercise activities are led by independent fitness instructors or other Event participants who are not employees or agents of CMN Hospitals. I agree not to hold CMN Hospitals responsible for the acts or omissions of the independent instructors or other Event participants. I understand that CMN Hospitals may, in its sole discretion and at any time, revoke my enrollment in the Event. Without limiting the foregoing, I consent to and authorize CMN Hospitals to take and use photographs, videos, films and/or audio recordings of me, to use my likeness, and to use my name and information provided. I acknowledge and agree that these materials and this information may be used for publicity, fundraising, awareness, promotions, campaigns and/or events throughout the world, in perpetuity, and may be edited or modified and used in any form of media by any manner (now and hereafter known). I waive the right to inspect or approve any such materials and information. CMN Hospitals shall be the sole owner of such materials and information, including all copyrights and all moral rights, throughout the world. CMN Hospitals may authorize hospitals, foundations, healthcare institutions, sponsors and/or others affiliated with CMN Hospitals to use such materials and information. I understand that this consent is irrevocable and permanent, and I will not receive any payment or other consideration, other than being permitted to voluntarily participate in this Event. Page 1 of 3 In consideration of my participation in this Event, I HEREBY FOREVER WAIVE, RELEASE, AND DISCHARGE CMN Hospitals, and its directors, officers, employees, agents, representatives, volunteers, contractors, successors and assigns (“Releasees”) from any and all loss or damage, and any claim or demands therefor, on account of injuries to my person or property or resulting in my death arising out of or related to the Event, whether caused by the negligence of Releasees or otherwise. I HEREBY AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS the Releasees from any loss, liability, damage, or cost that I may incur arising out of or related to the Event, whether caused by the negligence of Releasees or otherwise. I HEREBY ASSUME FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH, OR PROPERTY DAMAGE arising out of or related to the Event, whether caused by the negligence of the Releasees or otherwise. I HEREBY ACKNOWLEDGE AND ASSUME FULLY RESPONSIBILITY FOR ANY RISK as the activities of the event are DANGEROUS AND INVOLVE THE RISK OF SERIOUS INJURY AND/OR DEATH and/or property damage, and I expressly acknowledge that injuries received may be compounded or increased by negligent rescue operations or procedures. I ALSO HEREBY FOREVER WAIVE, RELEASE, AND DISCHARGE Releasees from any and all actions, claims, demands, causes or causes of action, liabilities, suits, obligations, damages, losses, costs, expenses, and equitable relief of any nature whatsoever, whether past, present or future, known or unknown, fixed or contingent, whether at law or in equity, in whatever form denominated, arising from this Release and/or my voluntary participation in this Event. I CERTIFY THAT I AM 18 YEARS OF AGE OR OLDER, AND I ACKNOWLEDGE THAT I HAVE READ THIS FORM IN ITS ENTIRETY AND FULLY UNDERSTAND IT. I UNDERSTAND THAT IT CONTAINS A RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, AND BY VOLUNTARILY SIGNING THIS DOCUMENT, I AM GIVING UP SUBSTANTIAL RIGHTS AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. If Participant is 18 years of age or older:
DOB: ___________________________
PARTICIPANT:
Date: ___________________________
Emergency Contact (Name & Phone Number):
Signature:_____________________________
____________________________________
Print: ________________________________
____________________________________
IF PARTICIPANT IS NOT OF LEGAL AGE, as the parent/guardian with legal responsibility for the Participant, I certify that I am 18 years old or older, and give my permission for my child/ward to participate in the Event. Further, as set forth above, I RELEASE AND AGREE TO INDEMNIFY, DEFEND AND HOLD HARMLESS the Releasees from any and all claims whether caused by negligence or otherwise, arising from this Release or related to my child’s/ward’s participation in the Event, to the fullest extent permitted by law. I, as the parent/guardian of the Participant, acknowledge that I have fully read this Release and understand and agree that Participant and myself are bound by this Release by my registration of Participant in the Event and/or Participant’s participation in the Event, and that I HAVE GIVEN UP SUBSTANTIAL RIGHTS OF PARTICIPANT FREELY AND VOLUNTARILY, WITHOUT ANY INDUCEMENT OR ANY OTHER REPRESENTATION, STATEMENT OR AGREEMENT FROM ANY PERSON. Page 2 of 3 If Participant is a Child under the age of 18 years old:
PARENT/GUARDIAN:
PARENT/GUARDIAN:
Signature:_____________________________
Signature:_____________________________
Print: ________________________________
Print: _________________________________
Date: _________________________________
Date: ________________________________
On behalf of (Participant):
_____________________________________
On behalf of (Participant):
______________________________________
Emergency Contact (Name & Phone Number):
Emergency Contact (Name & Phone Number):
____________________________________
____________________________________
____________________________________
___________________________________
Signing Instructions: Must be signed by both parents unless parent is single. If divorced, must be signed by parent having legal custody of Subject. If a guardian has been appointed for Subject, must be signed by guardian. Page 3 of 3